ENT
Allergic Rhinitis
الرجک رائنائٹس
Recurrent episodes of sneezing and watery nasal discharge without fever, usually triggered by dust or other allergens.
- ICD-10
- —
- Source
- OPD handbook pp.21–24
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Sneezing
- Watery nasal discharge
- Post-nasal drip
- Recurrent episodes
Diagnosis
- May show a deviated nasal septum
- Signs of inflammation in the nose
- No fever and no tachycardia, with recurrent episodes, points to allergic rhinitis
Treatment
Step 1 of 5
1. Antihistamine (choose one)
- Cetirizine causes sedation and congestion per the book
Prescription
CetirizineAntihistamine
Dose10 mg
Brand Rigix / Sedil / Zyrtec
Also sold as Rigix, Sedil, Antial, Neo-Antial, Cetrix, Zyrtec
Sedation and congestion
Step 2 of 5
2. Decongestants
- Xylometazoline (Xynosine) topical can be used in an acute attack but not for more than 5 days, because it can cause atrophic rhinitis
- Pseudoephedrine 60–120 mg, maximum 240 mg
Prescription
Xylometazoline (topical nasal decongestant)Topical decongestant
DoseTopical, maximum 5 days
Brand Xynosine
Fexofenadine + PseudoephedrineAntihistamine + decongestant
Dosepseudoephedrine 60–120 mg; maximum 240 mg/day
Brand Tab Fexet D 60/120 mg
Step 3 of 5
3. Topical steroid
Prescription
Fluticasone (nasal steroid spray)Topical corticosteroid
Dose2 puffs in the evening (per Urdu note), both nostrils
Brand Ticovate nasal spray
Step 4 of 5
4. Counselling and referral
- Avoid dust and smoke
- Wear a mask
- Avoid dander, birds, or any relevant triggering factor
- Opinion from an ENT surgeon for septoplasty if the septum is deviated
Step 5 of 5
5. Antibiotics (only if indicated)
- Indication: greenish / yellowish discharge, or the patient is febrile
Prescription
LevofloxacinFluoroquinolone antibiotic
Dose250 mg BD
Brand L-Cyn
Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo
Case scenario from the book
- Ali, 16 y, with episodic itching, sneezing and watery nasal discharge for 2 years. Currently continuous sneezing since morning triggered by dust. Has taken Tab Rigix for symptomatic relief for 1 month and symptoms are not well controlled. Nasal cavities are red with watery discharge on nasal speculum. Manage the patient.
- Prescription for the scenario: Tab Fexet-D 60/120 mg 1+1; Norsalin P drops, 8 drops three times a day in both nostrils; Ticovate nasal spray, 2 puffs in the evening in both nostrils; avoid dust and smoke; get checked by an ENT specialist (deviated nasal septum found on examination).